Provider Demographics
NPI:1598839680
Name:JORGENSEN, JERRY ROBIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ROBIN
Last Name:JORGENSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4913
Mailing Address - Country:US
Mailing Address - Phone:308-534-1870
Mailing Address - Fax:308-534-1871
Practice Address - Street 1:110 S SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4913
Practice Address - Country:US
Practice Address - Phone:308-534-1870
Practice Address - Fax:308-534-1871
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061036401Medicaid
350027451OtherRR MED
09511OtherBCBS
NE47061036401Medicaid
NE091520Medicare PIN